Citation Nr: 0613555
Decision Date: 05/10/06 Archive Date: 05/17/06
DOCKET NO. 04-15 759 ) DATE
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On appeal from the
Department of Veterans Affairs Regional Office in Atlanta,
Georgia
THE ISSUES
1. Entitlement to service connection for cervical spine
disability.
2. Entitlement to an increased rating for lumbosacral strain
with arthritis at L5, currently rated as 20 percent
disabling.
REPRESENTATION
Appellant represented by: Georgia Department of Veterans
Services
WITNESS AT HEARING ON APPEAL
Appellant
ATTORNEY FOR THE BOARD
L. Jeng, Associate Counsel
INTRODUCTION
The veteran had active duty from February 1984 to April 1985.
This matter comes before the Board of Veterans´ Appeals
(Board) from an August 2002 rating decision.
The veteran appears to have raised the issue of entitlement
to service connection for fibromyalgia. This issue is
referred to the RO for appropriate action.
REMAND
During her February 2005 hearing, the veteran indicated that
she received treatment for her disabilities at the Dublin,
Georgia VA Medical Center (VAMC). She also testified that
additional treatment records from R.A. Nelson, M.D. were
available. These records must be associated with the claims
folder prior to any further adjudication by the Board.
Additionally, the veteran has been assigned a 20 percent
rating for lumbosacral strain with arthritis at L5 under
Diagnostic Code 5295-5003. She has been diagnosed with
"chronic pain with left lower extremity radiculopathy from
lumbosacral strain." See VA Compensation and Pension
Examination Reports dated January 1990 and August 1998. The
veteran is entitled to have her claim reviewed under the
schedular provisions pertaining to intervertebral disc
syndrome (IVDS), and she must be provided VA examination
under a protocol consistent with the IVDS criteria.
Accordingly, the case is REMANDED to the RO via the Appeals
Management Center (AMC) in Washington, D.C., for the
following action:
1. Associate with the claims folder the
veteran's treatment records from the Dublin,
Georgia VAMC since August 1985.
2. After obtaining any necessary authorizations,
obtain the veteran's treatment records from R.A.
Nelson, M.D and associate them with the claims
folder.
3. Upon receipt of any additional evidence
and/or information, schedule the veteran for
orthopedic examination to determine the current
nature and severity of her lumbar spine
disability. The claims folder and a copy of this
remand must be made available to the examiner
prior to the examination for review. After
physically evaluating the veteran, the medical
examiner should address the following questions,
to the best of his/her medical knowledge:
a) What are the veteran's range of motion
findings in forward flexion, backward extension,
right and left rotation and right and left
lateral flexion?
b) Does the veteran have pain, pain on use,
weakness, incoordination, or excess fatigability
of the lumbar spine? If feasible the examiner
should portray any additional functional
limitation of the lumbar spine due to these
factors in terms of degrees of additional loss of
motion. If not feasible, this should be stated
for the record together with the rationale. If
the veteran does not have pain or any of the
other factors, that fact should be noted in the
file.
c) Does the veteran have muscle spasm or
guarding severe enough to result in an abnormal
gait or abnormal spinal contour such as
scoliosis, reversed lordosis, or abnormal
kyphosis?
4. Schedule the veteran for neurologic
examination to determine the current nature and
severity of the chronic neurologic manifestations
of her lumbar spine disability, if any. The
claims folder and a copy of this remand must be
made available to the examiner prior to the
examination for review. After physically
evaluating the veteran, the medical examiner
should address the following question, to the
best of his/her medical knowledge:
a) Identify all chronic neurologic
manifestations of the veteran's service connected
thoracolumbar spine disability, to include
specifying any and all neurologic symptoms (e.g.,
sciatica, neuritis, neuralgia, sensory loss,
sphincter and bladder dysfunction, etc.) with
reference to the nerve(s) affected (e.g., sciatic
nerve)
5. Thereafter, readjudicate the claim of
entitlement to an increased rating for
thoracolumbar spine disability. In so doing,
consider the schedular criteria pertaining to
evaluating IVDS. If the claim remains denied,
the veteran and her representative should be
provided an SSOC. An appropriate period of time
should be allowed for response.
Thereafter, the case should be returned to the Board, if in
order. The veteran need take no action unless otherwise
notified, but she may submit additional evidence and argument
on the matter the Board has remanded to the RO.
Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim
must be afforded expeditious treatment. The law requires
that all claims that are remanded by the Board of Veterans'
Appeals or by the United States Court of Appeals for Veterans
Claims for additional development or other appropriate action
must be handled in an expeditious manner. See 38 U.S.C.A. §§
5109B, 7112 (West Supp. 2005).
_________________________________________________
T. MAINELLI
Acting Veterans Law Judge, Board of Veterans' Appeals
Under 38 U.S.C.A. § 7252 (West 2002), only a decision of the
Board of Veterans' Appeals is appealable to the United States
Court of Appeals for Veterans Claims. This remand is in the
nature of a preliminary order and does not constitute a
decision of the Board on the merits of your appeal.
38 C.F.R. § 20.1100(b) (2005).